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Purpose of Review: Hepatitis B virus (HBV) infection is a global public health issue. While cirrhosis and hepatocellular carcinoma commonly affect patients with chronic HBV, extrahepatic manifestations are often unappreciated. Recent Findings: Extrahepatic manifestations can be variable in presentation but include several commonly described syndromes including HBV-related nephropathy, vasculitides, dermatitis, and arthritis. However, recently described entities include hematologic and neurologic manifestations. Summary: The primary immune-mediated mechanism common to many extrahepatic manifestations involves viral antigen-triggered immune complex formation. Initiation of antiviral treatment is associated with clinical response in most cases of extrahepatic disease; thus, recognition of these manifestations is essential to mitigating associated morbidity and mortality. [ABSTRACT FROM AUTHOR]

A patient with systemic amyloidosis developed portal hypertension, acute liver failure and multiorgan dysfunction. Extensive testing was unrevealing for paraproteinemia, plasma cell dyscrasia, infectious, or inflammatory conditions. He was transferred to our institution for orthotopic liver transplant evaluation but was ultimately declined given clinical instability and dysautonomia. Post-mortem evaluation revealed extensive amyloid deposition in multiple organs determined to be AL-lambda amyloidosis. [ABSTRACT FROM AUTHOR]

Background: Patients with end-stage liver disease (ESLD) have high mortality, but low utilization of palliative care. A transitional care liver clinic (TCLC), bridging inpatient hepatology care to outpatient clinics, should offer the ideal setting for advance care planning (ACP). Objective: To examine ACP and related outcomes for TCLC patients who died within one year of the initial TCLC visit. Design: Retrospective chart review. Setting: Nontransplant eligible ESLD patients, seen in TCLC postdischarge from an inpatient liver unit. Measurements: Charts were reviewed for demographics, clinical data, ACP discussions, code status, location of death, and palliative care consultations. Results: Of the 58 patients who showed for the initial TCLC visit, 18 (31%) died within one year. Most patients were men (67%) with alcoholic cirrhosis (72%), Child-Pugh class C (55.5%) and median age of 56 years (37–72 years). There were no ACP discussions in any TCLC visits even after subsequent hospitalizations. Until their terminal hospitalization, 17 patients (94%) remained full code. Palliative care was consulted for 10 patients (56%). Despite late initiation, within two weeks of death for 6 of those 10 patients, palliative care consultation facilitated arrangements for out-of-hospital death: at home or inpatient hospice (70% vs. 12%, p = 0.01). Conclusions: Despite a structured program for ESLD patients, there were no ACP discussions until the terminal hospitalization. These findings support the need to integrate palliative care interventions in the management of ESLD patients, especially taking advantage of postdischarge visits. [ABSTRACT FROM AUTHOR]

Background: The association between obesity and rising incidence of hepatocellular carcinoma (HCC) in the USA has been documented; however, the role of bariatric surgery remains less clear.Aim: To evaluate the cross-sectional association of prior-bariatric surgery and HCC.Methods: The United States Nationwide Inpatient Sample (NIS) database was queried from 2004 to 2014 for discharges with a diagnosis of morbid obesity. Primary outcomes of interest were HCC and in-hospital mortality rate. Secondary outcomes were length of stay and cost. Baseline characteristics were balanced using propensity score matching (PSM). Using Poisson and logistic regressions, adjusted HCC prevalence ratio (PR) and mortality odds ratio (OR) were derived in patients with prior-bariatric surgery compared to those without bariatric surgery.Results: Of the 2,881,414 patients included in our study, 267,082 (9.3%) underwent bariatric surgery. From 2004 to 2014, there was a threefold increase in age-adjusted prevalence of HCC from 27 per 100,000 to 72 per 100,000 (PTrend< 0.001). After PSM, 230,956 patients with prior-bariatric surgery were matched with 230,956 patients without bariatric surgery. Prior-bariatric surgery was associated with lower prevalence of HCC (PR 0.11; 95% CI, 0.03-0.48; P < 0.001). In-hospital mortality was also lower for patients with surgery (OR 0.22; 95% CI, 0.20-0.26; P < 0.001). The occurrence of HCC added $18,840 extra cost, increased mean length of stay by 2 (95% CI; 1-3) days, and increased risk of death by 65% (aOR 1.65; 95% CI 1.18-2.29).Conclusion: In this nationwide study of morbidly obese patients, prior-bariatric surgery was associated with a lower prevalence of HCC and lower in-patient mortality. [ABSTRACT FROM AUTHOR]

Acute pancreatitis is a leading cause of hospitalization within the United States, stemming from a variety of potential causes including druginduced pancreatitis. Although a host of potential drugs have been implicated, cases of acute pancreatitis have been described with use of canagliflozin and dapagliflozin, sodium-glucose cotransporter 2 (SGLT-2) inhibitors. Notably, another SGLT-2 inhibitor, empagliflozin, has not been previously identified as having an association with pancreatitis. Here we report a case of a 52-year-old female who presented with epigastric pain and elevated lipase after initiation of empagliflozin one-month prior. We review the case and provide an in-depth clinical review of drug-induced pancreatitis with discussion of potential mechanisms. Given the efficacy and rapid adoption of SGLT-2 inhibitors in clinical practice, it is pivotal for providers to have high index of suspicion and perform a careful drug history if adverse events such as drug-induced pancreatitis occur. [ABSTRACT FROM AUTHOR]